Your reveal device

A Reveal device is designed to monitor and record an ECG when the electrical system in your heart fails to work normally and your heart beats too slowly, too fast. You can also tell it if you feel palpitations or other symptoms by using the patient activator.

1. If your heart beats too slowly (known as ‘heart block’ or ‘sino-atrial node disease’) you may have experienced shortness of breath or may even have fainted.
2. Some people have both a slow and a fast heart rate. A pacemaker is designed to take over when the heart is beating too slowly. The loop recorder is not a pacemaker; it acts purely as a monitor.

Your doctor will explain the need and the reasons for fitting it.

What happens before the procedure?

You will be checked in with the Pre-assessment clinic beforehand. This will be done either in the Cardiac Catheter lab or in a pacing pre assessment clinic.

Female patients

If you are or think you might be pregnant please ring the Catheter lab on 020 8321 2618. We will need to carry out a pregnancy test on your arrival for your procedure.

Eating and drinking

Please follow the instructions given in your confirmation letter about when to eat and drink before your appointment. It is important that you stick to these. We will remind you of the times in your pre assessment.

Medication

For your pre admission appointment we will ask you to bring in a list of all your current medications. We will then advise you of any medications you need to stop before the procedure.

Warfarin and other anticoagulants

You may need to stop taking warfarin or other anticoagulants (such as apixaban, rivaroxaban, edoxaban or dabigatran) before your procedure. This depends on the type of procedure planned and your specific medical history; your Consultant will discuss this with you.

On the day of your procedure please take the rest of your medication. You may prefer to take your diuretic (water tablets) after the procedure.

Please bring all of your medication with you (including your diabetic medication or other specialist inhalers or creams).

Preparing to come to hospital

Shaving- Please do not shave or remove the hair from your chest, arms or legs before coming to hospital. If needed this will be done for you in hospital.

Hygiene- It is important to have a shower or bath before coming into hospital. Please ensures your nail polish is removed and that you are not wearing lots of make-up.

You will be in hospital for a few hours; please make sure you bring something to read or listen to with headphones. You will also need to bring slippers and a dressing gown. You will also need loose clothing to go home.

You may need someone to take you home if you have had sedation.

Coming in to hospital

Please arrive promptly as stated the time on your letter. A number of tests will happen when you arrive so you are ready for your procedure. These will be done by the nurse. You may need to repeat some of the questions asked in the pre assessment.

After this one of the specialist heart doctors performing the test will come and see you to consent you for the procedure. They will explain the risks and the benefits of the test and what it entails. You will receive an information booklet detailing this information prior the procedure. Please take the time to read this before you attend.

We will try not to keep you waiting but sometimes this cannot be avoided. We are the only catheter suite in the hospital so if there are emergencies, there can be delays to your case. We will do our best to keep you up to date and will always be happy to discuss things if you have concerns.

During the procedure

You will be brought into the catheter lab by one of the members of the team. In the room you will meet the team looking after you- nurses, radiographer, physiologists and doctors.

You’ll be asked to lie on the x-ray table, and one of the team will stick ECG stickers on you. Each member of the team in turn will introduce themselves and explain their roles in the lab. A safety check will be carried out and you will hear your name and other information about the case. You will also notice that all staff are wearing hats and facemask- this is completely normal.

Once the team are ready, we will expose the area where the device will be inserted. This will be cleaned with a sterile liquid which is very cold. Lots of drapes will be draped over you and your face maybe covered whilst we set up, but this soon will be removed.

Local anaesthetic is injected into a small area of your chest. A tiny incision (cut) is made in the skin and the device is then inserted into a small ‘pocket’ under the skin, just below the incision. Modern devices are very small and once in place they are hardly noticeable.

After the procedure

After the test, we will take you back to the day ward, where you will be able to have some food and drink when you feel ready.

You will be with us after the procedure for around 1 to 2 hours.

The doctor and the physiologist will come and explain and talk to you before you leave.

Going home

When you get home, we recommend that you relax for the rest of the day. You may eat and drink normally. If you have been given medication to take please follow the instructions carefully and take as prescribed. If necessary, you can take painkillers such as Paracetamol. You will also have a small wound where the device is inserted. Please keep it dry for 2 days.

If you notice any swelling, discharge or you think it is infected, please contact us on: Cardiac Catheter lab: 020 8321 2618 Monday to Friday 8am to 6pm or Coronary Care Unit: 020 8321 6944/ 6582.

Once home

• Physical contact sports are not usually advisable for at least 4 weeks.
• You will need to carry a device identification card and remember to tell healthcare staff that you have a device. You can have Magnetic Resonance Imaging (MRI) but the device MUST be downloaded before the scan and you MUST tell the scanning department in advance that you have a device fitted.
• The device lasts up to three years, after the battery is depleted or if the device is no longer needed, it can be removed. It needs specialist disposal by the hospital.

Work

You should be able to return to work the next day, but people recover at different times so please discuss this with your team.
It is important to remember that some working areas can affect your device; please ask the team.

Complications

With all procedures there is a small amount of risk, the cardiologists will weigh all the information and speak to you about these before the procedure.

Common complications include:

• Bruising around the wound will affect about twenty people in a hundred, but will only affect about one of those seriously. This might delay your discharge home or require further treatment. The lump will gradually disappear and does not normally require any treatment.

Later complications can include:

• Infection of the wound and device pocket. This may result in the device needing to be removed. This happens in less than one in a hundred cases. Antibiotics are usually given to counteract this at the time the device is inserted.
• Skin erosion or ‘tethering’ means that the skin gathers over the pacemaker site or occasionally the stitch line re-opens. These complications affect about five in a thousand cases. Both complications may be related to a low grade infection, meaning that an urgent visit to the pacing clinic is needed

Contact details:

Cardiac Cath lab: 020 8321 2618
Monday to Friday 8am to 6pm